Provider Engagement Account Manager Job at WellCare of North Carolina, Greensboro, NC

TERDMVBrUVoxSS9BNnpGcGppM21BOEEyb1E9PQ==
  • WellCare of North Carolina
  • Greensboro, NC

Job Description

Job Description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Position is based in Greenville, NC area.

Position Purpose: Maintain partnerships between the health plan and the contracted provider networks serving our communities. Build client relations to ensure delivery of the highest level of care to our members. Engage with providers to align on network performance opportunities and solutions, and consultative account management and accountability for issue resolution. Drive optimal performance in contract incentive performance, quality, and cost utilization.

  • Serve as primary contact for providers and act as a liaison between the providers and the health plan
  • Triages provider issues as needed for resolution to internal partners
  • Receive and effectively respond to external provider related issues
  • Investigate, resolve and communicate provider claim issues and changes
  • Initiate data entry of provider-related demographic information changes
  • Educate providers regarding policies and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topics
  • Perform provider orientations and ongoing provider education, including writing and updating orientation materials
  • Manages Network performance for assigned territory through a consultative/account management approach
  • Evaluates provider performance and develops strategic plan to improve performance
  • Drives provider performance improvement in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc.
  • Completes special projects as assigned
  • Ability to travel locally 4 days a week
  • Performs other duties as assigned
  • Complies with all policies and standards

Education/Experience: Bachelor’s degree in related field or equivalent experience. Two years of managed care or medical group experience, provider relations, quality improvement, claims, contracting utilization management, or clinical operations. Project management experience at a medical group, IPA, or health plan setting. Proficient in HEDIS/Quality measures, cost and utilization.

Pay Range: $54,000.00 - $97,100.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.


Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Job Tags

Holiday work, Contract work, Remote job, Flexible hours,

Similar Jobs

Plex Integrated System Solutions, LLC

Telecommunication Technician Installer Job at Plex Integrated System Solutions, LLC

 ...install complete video conferencing systems. Sell business phones and provide phone service (VOIP). We also sell and install Sirius XM radio for businesses. Now doing installation for Toast and Revel point of sale systems. Company Description We provide all equipment... 

ServiceMaster Restoration by Advanced

SCHOOL CUSTODIAN-SECOND SHIFT Job at ServiceMaster Restoration by Advanced

 ...custodian applicants for several local accounts as well as various schools. Hours and schedules can vary. Responsibilities include:...  ...-other duties not listed may also be assigned. ~ Perform all cleaning duties using provided products, tools and procedures ~ Duties... 

New Mexico Gas Co - Peoples Gas - Tampa Electric

Spring 2025 Government Affairs Student Job at New Mexico Gas Co - Peoples Gas - Tampa Electric

 ...Title: Spring 2025 Government Affairs Student Company: Tampa Electric Company State and City: Florida- Tallahassee...  ...abilities. Pay Transparency Non-Discrimination Statement The contractor will not discharge or in any other manner discriminate against... 

CHRISTUS Health

RN, Registered Nurse Clinical Educator II - Nursing Education Job at CHRISTUS Health

 ...Job Description Description Summary: The Registered Nurse Clinical Educator II (RNCE) will assess, plan, coordinate, implement and evaluate the clinical opportunities and strategies for improving delivery of diabetic patient care and staff education regarding... 

Atrium Health

Atrium Health | Registered Nurse (RN) Weekend Program Nights- Atrium Health Cabarrus Cardiac Stepdown | concord, nc Job at Atrium Health

Overview DO NOT POST Associated topics: bsn, cardiothoracic, ccu, domiciliary, intensive, mhb, psychiatric, registed, registered nurse, tcu